Application of Topical Negative Pressure (Vacuum-Assisted Closure) to Split-Thickness Skin Grafts

Azzopardi, Ernest A.; Boyce, Dean E.; Dickson, W.A.; Azzopardi, Elayne; Laing, Hamish; Whitaker, Iain S.; Shokrollahi, Kayvan

doi:10.1097/sap.0b013e31826eab9e

Cited by 77 publications

(69 citation statements)

References 31 publications

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“…Nevertheless, split-skin take was rather high when using TNP. These findings are in accordance with the outcome in nondiabetic burn patients 12,13 and may be explained by the reduction of hematoma and seroma and better graft fixation on the wound bed with reduced shear stress. 19 Different factors can delay the wound healing process.…”

Section: Discussionsupporting

confidence: 91%

“…8,9,11 It is known that topical negative pressure (TNP) dressings alias negative pressure wound therapy can increase graft take rate, even in burned patients. 12,13 However, the effectiveness of TNP on grafts in diabetic patients with foot scalds has never been reported. Therefore, we compared the outcome of antiseptic dressing with a circular TNP dressing on the freshly laid split-thickness skin graft (SSG) after tangential excision in insulin-dependent diabetes mellitus (IDDM) patients after deep dermal scald of the foot (Figures 1 and 2).…”

Section: Introductionmentioning

confidence: 98%

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Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients

Kisch

Liodaki

Mauss

et al. 2015

Journal of Burn Care & Research

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The incidence of insulin-dependent diabetes mellitus (IDDM) is expected to increase significantly. Due to peripheral neuropathy and angiopathy in IDDM patients, feet scalding results in deep burn injuries. Regularly amputations are needed with tremendous consequences. In relatively healthy patients, split-skin graft (SSG) take is better when topical negative pressure (TNP) is applied. We compared the outcome of circular TNP dressing with that of antiseptic dressing on freshly laid SSG after tangential excision in IDDM patients with deep dermal foot scalds. Seventy patients admitted to a burn center with isolated foot burns were identified (2008-2013). Ten of them suffered from IDDM and presented with a deep dermal foot scald. After tangential excision and split-skin grafting, five of them were treated with TNP. The others received an antiseptic dressing regime. Differences were analyzed using either Chi-square or Student's t-test. Group comparison regarding age, gender, body mass index, HbA1c on arrival, glucose in serum, IDDM disease duration, and TBSA revealed no significant differences. But percentage of graft take was at a significantly higher rate in the TNP group (90.2 ± 4.017 vs 39 ± 15.362) and fewer operations had to be performed compared to the control group (2.0 ± 0.447 vs 4.6 ± 0.927). Due to reduced occurrence of necrosis, the number of amputations required was significantly lower in the TNP group. TNP application on freshly laid SSG following tangential excision in IDDM patients after deep dermal foot scalds minimized amputation rates and therefore is of great benefit for such patients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 98%

Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients

Kisch

Liodaki

Mauss

et al. 2015

Journal of Burn Care & Research

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“…In agreement with the recommendations of Azzopardi et al 68 , the highest recommendations of the NPWT-EP were related to split-thickness skin-graft procedures and indicated that NPWT must be considered to improve splitthickness skin-graft success (quality of evidence, grade A), should be considered in high-risk patients or wounds (quality of evidence, grade B), and should be left undisturbed for three to seven days on continuous pressure (quality of evidence, grade B).…”

Section: Levels Of Evidence and Recommendationssupporting

confidence: 90%

“…Azzopardi et al 68 , in their evidencebased literature review from the past decade, made three recommendations. First, NPWT application to splitthickness skin grafts may promote blood flow at the graft bed and surrounding wound while stimulating angiogenesis and basement membrane integrity (quality of evidence, grade C).…”

Section: Management Of Skin Grafts and Flapsmentioning

confidence: 98%

Negative-Pressure Wound Therapy in Acute Traumatic and Surgical Wounds in Orthopaedics

Harvin

Stannard

2014

JBJS Rev

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“…Following reconstructive surgery with a caudal sartorius myocutaneous flap, VAC therapy was applied at 50 mmHg. Although some authors make recommendations that subatmospheric pressure settings of only 50 mmHg are needed to reduce edema over closed incisions or skin grafts, clinical cases report a 95% success rate with split thickness skin grafting and adjunctive negative pressures between 75 and 125 mmHg [7,[21][22][23]. The negative pressure setting of 50 mmHg was chosen based on clinical experience with skin grafts treated adjunctively with VAC therapy at our institute.…”

Section: Discussionmentioning

confidence: 99%

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

Shomper

Coutin

Lanz

2013

Case Reports in Veterinary Medicine

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Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM) pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC) in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap.

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Application of Topical Negative Pressure (Vacuum-Assisted Closure) to Split-Thickness Skin Grafts

Cited by 77 publications

References 31 publications

Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients

Reduced Amputation Rate by Circular TNP Application on Split-Skin Grafts After Deep Dermal Foot Scalds in Insulin-Dependent Diabetic Patients

Negative-Pressure Wound Therapy in Acute Traumatic and Surgical Wounds in Orthopaedics

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

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